dental health counselling

2. NUTRITION AND COMMUNICATION
IN EDENTULOUS PATIENTS

4.  INTRODUCTION
 DEFINITIONS
 ROLE OF A DENTIST
 COMMUNICATION WITH GERIATRIC PATIENT
 HOUSE CLASSIFICATION OF MENTAL ATTITUDE
 NUTRITIONAL OBJECTIVES
 FACTORS CONTRIBUTING TO NUTRITIONAL PROBLEMS
 CLINICAL SIGNS OF NUTRITIONAL DEFICIENCY
 DIETARY COUNSELING OF GERIATRIC PATIENTS
 CONCLUSION
 REFERENCES

5. o Geriatric dentistry deals with delivery of dental care to the elderly citizen. It is
concerned with diagnosis, prevention and treatment of dental problems
associated with normal aging.
o Dentistry for elderly must be practiced with increased awareness of the biologic
factors ,since the adaptive mechanism and tissue regeneration potentials in the
elderly patients are usually significantly lowered.
o The elderly require a different approach, modified treatment planning, and
knowledge of how the tissue changes associated with senescence affect oral
health service.

6. AS STATED BY GPT -9,
• 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.
• GERIODONTICS : 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 process.

7. • NUTRITION : 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)
• DIET : It is defined as the types and amounts of food eaten by an individual.(FDI)
• BALANCED DIET : A diet that contains the proper proportions of carbohydrates, fats,
proteins, vitamins, minerals ,and water necessary to maintain good health.
• BASAL METABOLIC RATE : It is defined as the number of kilocalories expended by the
organism per sq metre of body surface per hour.(K cal/sq m/hr).
• A nutritional assessment is used to determine the nutritional status of a person or group
of people. The ABCDs of nutritional assessment: anthropometric assessment,
biochemical assessment, clinical assessment and dietary assessment.

8.  Treatment of the aging can be difficult.
 When the dentist does not have the time , patience or knowledge to treat the patient refer
to a dentist with those qualifications.
 DENTAL OPERATORY/ OFFICE-
• Reception– well lighted and furnished.
• Seats – easy to get in and out.
• Floor covering—non slippery.
• Walking space – no obstacles.
• Décor– cheerful.
• Reading material– constructive, not trite or obsene.
• Safe pleasing waiting room.
• Dental chair– not contoured, have cup type head rest, adjustable arm and foot rest.
Heartwell CM, Rahn AO. Diagnosis. Syllabus of complete dentures. 4th edn.pp:106-42

9. De Van stated it well when he said “we should meet the mind of the
patient before we meet the mouth of The patient.”
For prosthodontic ventures to be successful, minds as well as mouths
must be individually understood and treated.
Communication is essential because it is an act of sharing. It is
participation in a relationship involving a deep understanding of the
patient.Dentists are considered to be masters of technical skills, able to
provide quick solutions to problems best solved through patiently and
effectively communicating with patients.
Patient-Dentist Communication: An Adjunct to Successful Complete Denture Treatment
Journal of Prosthodontics 19 (2010) 491–493 c 2010

10. BENEFITS OF EFFECTIVE
COMMUNICATION

12. Communication techniques used by Dental professionals :
DOMAIN TECHNIQUE
PATIENT FRIENDLY
PRACTICE
Ask learning style
Refer patient to the web
Use translator
TEACH-BACK METHOD
Patient repeats information
Patient repeats instructions
PATIENT FRIENDLY
MATERIAL AND AIDS
Video
Printed materials
Models or radiographs
INTERPERSONAL
COMMUNICATION
Include family
Use pictures
Speak slowly
Use simple language

13. • Problem due to partial or total loss of hearing. Also there may be
language issues.
• Try to talk to the patient in a language he/she understands.
• Try to avoid medical terms which patient doesn’t understand.
• Losing patience– frustration and confusion.
• Allow the patient to talk freely about his problems. End- when patient
starts to repeat.
• If other specific information is required- family members or physician
may be consulted.
COMMUNICATION PROBLEMS
Heartwell CM, Rahn AO. Diagnosis. Syllabus of complete dentures. 4th edn.pp:106-42

14. METHODS TO IMPROVE DENTIST – PATIENT RELATIONSHIP
 Use the golden rule. Treat the patient as you would like to be treated with
kindness and consideration .All attempt to establish rapport.
 Seat the patient at ease and sit opposite.
Use simple language. No patient likes to admit to ignorance, but
unwillingness to ask the meaning of a word might prevent important details
being provided.
Speak slowly,clearly,and lucidly. Special problems are encountered in
communication with elderly complete denture patients. Deafness is
common.
Use patient friendly educational materials to enhance the relationship.
Patient-Dentist Communication: An Adjunct to Successful Complete Denture Treatment
Journal of Prosthodontics 19 (2010) 491–493 c 2010

15.  Strong interpersonal skills are often the necessary ingredient for
patients’ development of trust in the prosthodontist.Such as :
 Greet every person by name. People love to be acknowledged by name.
When patients are addressed by their first name ,they believe the dentist is
interested in them.If a patient is older than the prosthodontist, always use his
or her last name with the appropriate honorific (Mr., Ms., Dr.).
 Never interrupt. When a patient is interrupted, he or she often feels that the
prosthodontist does not value what was said. When patients feel that the
prosthodontist is listening to them and taking time to answer their questions
,treatment acceptance increases.
 Smile . Smiling is an important way for the prosthodontist to let patients know
the prosthodontist is happy to see them and appreciates them.
THE INTERPERSONAL FACTOR
Patient-Dentist Communication: An Adjunct to Successful Complete Denture Treatment
Journal of Prosthodontics 19 (2010) 491–493 c 2010

16. The successful prosthodontic treatment depends on both Technical skills and Patient management,
according to mental attitude.
MENTAL ATTITUDE of a patient was classified by HOUSE in 1950 as :
o PHILOSOPHICAL :
• This is the ideal Patient Type.
• Patient is optimistic,cooperative,rational and sensible.
• Desires dentures for maintenance of health and appearance.
• The prognosis is good in such patients.
o EXACTING :
• This patient are far less than ideal.
• They are precise and can make unreasonable demands to the dentist.
• Likes explanation for each step in detail.
• The prognosis varies fair/poor.

17. o HYSTERICAL:
• This type of patient are often excitable,nervous,excessively hypertensive and
often very pessimistic.
• They may require professional psychological councessilng in before
treatment.
• The prognosis often remains unfavourable.
o INDIFFERENT :
• They lack motivation and might be unwilling to follow instructions regarding
his/her oral health.
• Most diificult category of patient to be treated.
• Such patients seek treatment not because of concern for his/her dental health
but because of some relatives who suggests them.
• The prognosis is poor.
Heartwell CM, Rahn AO. Diagnosis. Syllabus of complete dentures. 4th edn.pp:106-42

18. M.M.HOUSE CLASSIFICATION REVISTED:
• Although House's system was an important contribution, it failed to consider
the dentist's emotional reaction to a patient's behavior as part of an
understanding of how the patient and doctor cope with the dental treatment.
• This expanded classification system is based on empiricism and awaits
scientific validation or clinical application to determine its ultimate validity,
reliability, and effectiveness.
• The proposed classification is based on two factors:
1) the level and quality of the engagement or involvement of the patient
toward the dentist.
2) the level of willingness to submit(trust) to the dentist.
M. M. House mental classification revisited: Intersection of particular patient types and particular
dentist's needs: Simon Gamer,Richard Tuch and T.Garcia.( J Prosthet Dent 2003,89:297-302)

19. IDEAL :
• Corresponds to House’s philosophical mind, is reasonably engaged
and reasonably willing to submit (trust) to the dentist.
• They recognize their responsibility,along with the dentist’s, as an active
partner in the treatment.
• The ideal patient asks questions and challenges the dentist if
something does not seem right.
• They possess best treatment outcomes.
SUBMITTER:
• These patients tend to idealize the dentist, which results in a high degree of
engagement and surrender.
• Incapable of providing genuine informed consent.
• Cannot be an active partner in the treatment.

20. RELUCTANT:
• Such patients are low on engagement and on willingness to submit (trust).
• He/she is often leery of the dentist and skeptical of the treatment plan.
INDIFFERENT:
• Corresponds to House’s indifferent mind, rates very low on engagement and on
willingness to submit (trust).
• They seek treatment because of certain family members, relatives , friends who coerce
them.
RESISTANT:
• This patient corresponds to House’s exacting mind .
• Rather than being dependent, they challenge the dentist.
• And, like the indifferent patient, there is no trust.

23. • Relationship between oral and general health Particularly pronounced among elderly
Poor oral health
Poor general health
Low immunity
system
Compromised chewing and eating
Reduced nutritional intake

24. To establish a balanced diet which is consistent with the
physical, social, psychological and economic background of
the patient.
To provide temporary dietary supportive treatment, directed
towards specific goals such as carries control,
postoperative healing, or soft tissue conditioning.
To interpret factors peculiar to the denture age group of
patients, which may relate to or complicate nutritional
therapy.
Naik N et al., Int J Dent Health Sci 2015; 2(4):826-833 :DIET GUIDELINE FOR
GERIATRIC PATIENT
,ALITERATURE REVIEW

25. 1. Physiological aspects
2. Psychosocial aspects
3. Drugs
4. Economic factors
5. Changes in oral conditions
Nutrition for geriatric denture patients : Bandodkar,Meena Aras
The Journal of Indian Prosthodontic Society | March 2006|vol 6|Issue 1

26.  PHYSIOLOGICAL
FACTORS:
• Gradual loss of
function in most
organs and
tissues of the
body with AGING
• These changes are
slow and influenced
by -
• genetics
• socioeconomic
status
• illness
• life events
• accessibility of
health care
• environment.
These changes take
place at different rates,
not only between
individuals, but within
individuals.

27. Decrease in BONE DENSITY:
• 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 men.

28. 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,
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.

29. Gastrointestinal functioning:
• decreased peristalsis
• decreased hydrochloric acid secretion
• altered oesophageal motility
• Reductions in levels of some digestive enzymes including – salivary
amylase,pancreatic amylase, lipase,trypsin and pepsin.
 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 stomach
Reduced gastric mobility causing delayed emptying of
Stomach.
 Reduction in hunger contractions and often leads to constipation too.Overall disorders of GIT in
with age.

30.  PSYCHOLOGICAL 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

31.  DRUGS:
 Older people are 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.
 ECONOMIC
 E
c
F
o
A
n
C
o
T
m
O
i
R
c
S
f
a
:ctors 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.

32.  CHANGES IN ORAL STATUS OF THE ELDERLY:
Mucous membrane
The mucous membranes of the lips,the buccal and palatal tissues and the
floor of the mouth change with age,
• Gums of an adult person are marked shiny and with a stretched appearance.
• Decreased resilience and elasticity,epithelium is thin and friable.
• If the salivary deficiency is pronounced,the oral mucosa may be dry,atrophic, and
sometimes inflamed ,but more often it is pale and translucent.
• It is important to understand this clinical condition and handle geriatric patient with
utmost care.
• Dental surgeons should be very careful and should avoid any trauma during
Treatment.

33. These changes potentially have an impact on food choices.
In denture patients,it can affect adaptation of the prosthesis and may lead to the development of
Denture related problems.
Marked shiny appearance Thin and friable epithelium

34. Tongue:
Dorsum shows reddening, atrophy of papillae.
Altered taste and decreased appetite.
Increased varicosity at the ventral surface.
Macroglossia, is mainly because of loss of tone of muscles
of the cheek or expansions or oral cavity as result of loss of
teeth.
Atrophy of papillae
Glossodynia or burning tongue, is seen in many adults, sometimes with no apparent
clinical picture. It may be vitamin deficiency.
Fissuring and cracks due to aging

35. SALIVARY FUNCTION:
 XEROSTOMIA : Dry mouth condition due to decreased salivary flow. Commonly found in elderly
people
Also known as : Cotton mouth
Drough mouth
Des(desert like)
Clinical signs of xerostomia:
Dryness of lining of oral mucosa.
Oral mucosa appears thin,pale and feels dry.
Tongue may manifest deficiency by atrophy of papillae.
Inflammation,fissuring,cracking and denudation.
Burning and tingling sensation on mouth.
Patient aslo gets difficulty in swallowing,speech,eating dry
food.
Fissuring,cracking and denudation

36. Diabetes mellitus
Sjogren syndrome
Sarcoidoisis
HIV infection
Antihisatminic
Antidepressants
Antihypertensives
Anticholinergics
Sedatives
Angiolytics
Salivary gland aplasia
Smoking
Mouth breathing
Decreased
mastication

37. 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 bolus.
• It makes the mouth sore and chewing painful.
• It makes swallowing difficult due to loss of saliva’s lubricating effect.
• It causes changes in taste perception.

38. EDENTULISM:
• Edentulism increases with age.
• It is generally agreed that one third to one half of elders above 65yrs are
edentulous in both maxillary and Mandibular arches.
• Lack of dentition doesn’t 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 (Individuals with
poor dentition consume soft, easily chewed foods that are low in fibre and
have a low nutrient density, frequently.)

39. ALVEOLAR BONE LOSS:
• Alveolar bone density,like skeletal mass declines with advancing age.
• The rate at which this occurs is affected by oral hygiene,nutrition,genes,hormones,bone density
at Maturity.
• In persons with osteopetrosis 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 between systemic bone loss to jaw bone is unclear.Bone loss is accelerated
and bone height is diminished when teeth are lost.

42. VITAMIN A VITAMIN D

43. VITAMINS SOURCES DEFICIENCY
VITAMIN A
Liver,kidney,eggyolk,milk, cheese, butter,
fish liver oils
VITAMIN D
Fatty fish, fish liver oils, egg yolk, milk
Bitot’s spots (eyes),
Conjunctival and corneal xerosis
(dryness)
Xerosis of skin, Follicular
hyperkeratosis
Required for maintenance of bone
health and absorption of calcium
Bow legs,Beading of ribs
Mental confusion, Irritability, Beri
Beri, stunted growth
Cereals, pulse, oil seeds
,nuts,yeast,pork,liver,heart,kidney,milk
VITAMIN B1/THIAMINE
MiLk and milk products, cereal fruits,
vegetables and fish
VITAMIN B2/RIBOFLAVIN
Fissuring and redness of eyelid
corners and mouth, Magenta
colored tongue

44. VITAMINS SOURCES DEFICIENCY
VITAMIN C
Citrus food,Amla, guava, tomatoes, green
vegetables potatoes etc.
Bleeding in the gums,Delayed wound
healing,Hemorrhage and decrease
immunity
Meat, milk, fish, egg yolk, corn, wheat
VITAMIN B6
Liver, kidney, eggs,fish,chicken,milk,curd
VITAMIN B12
Folic Acid / Folacin
Green, leafy vegetables, Whole grains,
eggs, cereals ,liver , kidney beans
Depression,Irratibility,Nervousness,
mental confusion, Decrease in
hemoglobin levels
Megaloblastic anemia,Dementia,
Neuropsychiatric disorders,
Lethargy and Malaise.
Glossitis, Skin hyperpigmentation
Megaloblastic anemia

45. VITAMINS SOURCES DEFICIENCY
VITAMIN E
Vegetables oils (sunflower,soyabean etc)
sunflower seeds,green leafy vegetables.
Known as anti sterility vitamin.No
oral manifestations seen.
VITAMIN K
Fish, liver, eggs , cereals ,green leafy
vegetables,brocolli,prunes.
Spontaneous gingival bleeding and
Gingival haemorrhages.
Naik N et al., Int J Dent Health Sci 2015; 2(4):826-833 :DIET GUIDELINE FOR
GERIATRIC PATIENT
,ALITERATURE REVIEW

47. MINERALS FUNCTIONS/BENEFITS FOOD SOURCES
CALCIUM
Builds bones, teeth ,helps blood clot ,
Assist nerves and muscles.
PHOSPHORUS
Builds teeth and bones ,helps body to get energy
from foods
IRON
Forms integral part of red blood cells.
MAGNESIUM
Part of teeth and bones,helps body use
carbohydrates,helps to regulate muscle and nerve
contractions.
regulates energy
IODINE
SODIUM
& POTASSIUM
Controls water balance,regulates nerve impulses
and muscle contractions.
COPPER
Builds body cells,aids digestion and
absorption,regulates body temperature.
Milk,Cheese,Yogurt,Buttermilk,
tofu
Milk,milk products
,meat,fish,poultry,eggs,nuts.
Leafy vegetables,pulses,
cereals,fish,apples,dried fruits,
molasses,peas and beans.
Whole grain cereal,nuts,dried peas and
beans ,milk,meat,leafy greens.
Seafood,iodized salt.
Meat,milk and milk products,salt,fish
Poultry and vegetables.
All liquids water,coffee,tea,soft drinks
,fruits and vegetables juices .

48. RDA for protein: 0.8 – 1 gram/kg/day
Carbohydrates should represent 55-60% of the total
calories consumed
Dietary fat 30% or less, divided equally between saturated,
polyunsaturated and monounsaturated fats
ENERGY
REQUIREMENTS IN ELDERLY
PR
ATD
IEA
NTS
f:
or energy: 30kcal/kg/day
Nutrition for geriatric denture patients : Bandodkar,Meena Aras
The Journal of Indian Prosthodontic Society | March 2006|vol 6|Issue 1

49. Post menopausal women taking
estrogen supplements :1000mg/day
Post menopausal estrogen deprived
women : 1500mg/day
Supplementation needed for the
prevention and treatment of
osteoporosis
CALCIUM:

51.  Elderly are particularly susceptible to negative water balance,
usually caused by excessive water loss through damaged
kidney
 Inadequate intake of fluid will lead to rapid dehydration and
associated problems such as hypotension, elevated body
temperature, dryness of mucosa, decreased urine o/p and
mental confusion
 Under normal conditions, fluid intake should be atleast 30
ml/kg/day.
WATER IN GERIATRIC PATIENTS:

52. COMPOSITION OF BALANCED DIET FOR GERIATRICS OVER 60 YEARS:

53. • Caloric requirements decrease with advancing age, owing to reduced
energy expenditures and a decrease in basal metabolic rate.
• The mean RDA is 1600 Kcal for women and 2400 Kcal for men.

54. PROTEINS:
As the patients become older, the amount of protein
required increases.
•Protein depletion of body stores in the elderly, is seen
primarily as a decrease of the skeletal muscle mass.
Proteins is a must for denture wearers.
•The RDA for proteins, for persons aged 51 and over, is 0.8-
g protein/kg body weight per day.
•The best sources of proteins for the elderly diet are dairy
products, poultry, meats and fish in the boiled and not dried
form. Nuts, grains, legumes and vegetables contain protein,
which if eaten in the proper combination, is of the same
quality as animal sources of protein.
Nutrition for geriatric denture patients : Bandodkar,Meena Aras
The Journal of Indian Prosthodontic Society | March 2006|vol 6|Issue 1

55. CARBOHYDRATES:
• The elderly consume a large proportion of
their calories as carbohydrates, possibly at
the expense of protein, because of their low
cost, ability to be stored without
refrigeration and ease of preparation.
• The recommended range of intake is 50 to
60 per cent of total calories.
•Food sources include grains and cereals,
vegetables, fruits and dairy products.

56. FIBERS:
• An important component of complex
carbohydrates is fiber, which promotes
bowel function, may reduce serum
cholesterol and is thought to prevent
diverticular disease.
•Fiber in the form of bran is frequently
added to dry cereals and breads, but
vegetable fiber is more effective and less
expensive.
•Reduced selection of foods rich in fiber
that are hard to chew, could provoke
gastrointestinal disturbances in some
edentulous elderly, with deficient
masticatory performance.

57. 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..

58. PHYSICAL SIGNS OF NUTRITIONAL
DEFICIENCY

60. Xerosis of skin,
Follicular hyperkeratosis
Folic Acid
Vitamin B 12
Glossitis,
Skin hyper pigmentation
Glossitis,
Skin hyper pigmentation
Ascorbic acid
Iodine
Spongy, bleeding gums,
petechiae,
painful joints
Goitre
Vitamin D
Bow legs
Beading of ribs

61. • The quality of denture wearing patient’s diet can be improved with nutrition
counseling.
• One expectation of patients seeking new dentures is that they will be able to
eat a greater variety of foods.
• The main objective of diet counseling for patients undergoing prosthodontic
care is to correct imbalances in nutrient intake that interfere with body and
oral health.
• Patients receiving dentures should be carefully screened for nutritional risk
factors at the first appointment so that counselling and follow up can occur
during the course of treatment.
Zarb-bolender, Nutrition care for the denture wearing Patient 12th edn;pp 56-69

62. • Eating less than two meals per day.
• Diificulty in chewing and swallowing.
• Unplanned weight gain or loss of more than 10lbs in the last
6 months.
• Undergoing chemotherapy or radiation therapy.
• Loose denture or sore spots under denture.
• Oral lesions (glossitis,cheilosis or burning tongue)
• Alcohol or drug abuse.
• Unable to shop for,cook for ,or feed oneself.
Zarb-bolender, Nutrition care for the denture wearing Patient 12th edn;pp 56-69

63. • Eat a variety of foods.
• Build diet around complex carbohydrates (fruits,vegetables,
whole grain breads and cereals).
• Eat at least five servings of fruits and vegetables daily.
• Consume four servings of calcium rich foods daily.
• Limit intake of bakery products high in fat and simple sugars.
• Limit intake of prepared and processed high in sodium and fat.
• Consume eight glasses of water ,juice or milk daily.
Zarb-bolender, Nutrition care for the denture wearing Patient 12th edn;pp 56-69

64. • 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.
EATING WITH NEW
PROSTHESIS:

65. DIET CHART FOR DENTURE WEARER AFTER DENTURE
INSERTION
 First 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 - milk may be taken in any form
Meat group - for the first day or so eggs will be the first food choice; pureed meats, meat broths, or
soups may also be eaten
 Second Day & Third Day :
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.

66. Meat group- Fish, soft cooked chicken, eggs may be scrambled or soft cooked;
 Fourth Day :
Sore spots have healed, in addition to the soft diet, firmer foods can be eaten.
Should be cut into small pieces before eating.
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, its the ultimate in denture success.
Naik N et al., Int J Dent Health Sci 2015; 2(4):826-833 :DIET GUIDELINE FOR GERIATRIC
PATIENT,A LITERATURE REVIEW

67. If proper nutrition and a healthy diet is achieved !!

68. CLEANING OF DENTURES:
DENTURE DISINFECTANTS:

69.  Improper nutrition not only affects physical appearance but also it affects
psychological status of patient.
 The geriatric population,being a very important asset for our
society, their experience and guidance in real life are
indispensable. Many edentulous patients are “sick patients”. These
patients have deficient tissues on which to build dentures. One of the
most important factors of satisfactory prosthetic service is the nutrition
of the patient.
 The concluding principle is that proper nutrition is an important
aid in preventive medicine in geriatric people in which the
practicing prosthodontist can play a vital role.

70. 1. Zarb –Bolender : Prosthodontic treatment for patients, 12th edition
2. Glossary of Prosthodontic terms – 9. J. Prosthet Dent. May. 2017: e1-e105
3. Heartwell C.M. Jr. Syllabus of complete dentures. Fourth edition – 1986
4. Essentials of complete denture prosthodontics.3rd edition,Sheldon Winkler– 2015
5.Patient-Dentist Communication:An Adjunct to Successful Complete Denture
Treatment
Journal of Prosthodontics 19 (2010) 491–493 c 2010 by The American College of
Prosthodontists
6. Nutrition for geriatric denture patients : Bandodkar,Meena Aras
The Journal of Indian Prosthodontic Society | March 2006|vol 6|Issue 1

71. 7.Naik N et al., Int J Dent Health Sci 2015; 2(4):826-833 :DIET GUIDELINE FOR
GERIATRIC PATIENT,A LITERATURE REVIEW
8.M. M. House mental classification revisited: Intersection of particular patient types and
particular dentist's needs: Simon Gamer,Richard Tuch and T.Garcia.( J Prosthet Dent
2003,89:297-302)