Nutrition in complete denture patients and it's impact on physiological, anatomical structures in and around oral cavity. Prosthodontic considerations

1. Nutrition in
Complete
Denture Patients
Dr.Sona Sujai

2. Contents
Introduction
Definition
Physiological and anatomical changes
Psychological and financial changes
Nutrition in elderly
Prosthodontic considerations
Conclusion
References

3. Introduction
• Nutrition is greatly dependent on oral
health status.
• One in five of the older people reported
that oral condition prevented them from
eating the food of their choice.
• 15% took longer time to complete their
meal and their enjoyment of food was
limited by oral condition.
• 5% avoided eating certain foods because
of chewing problems.

4. • In patients with complete tooth loss,
prosthetic therapy not only restores the teeth
but also installs confidence in them.
• The longevity and stability of this complete
denture prosthesis depend on patients’
mucosal health.
• Any change in mucosa leads to ill-fitting
dentures and thus failure of treatment.
Mucosal health is determined by the type of
food a person consumes. Edentulous
individuals consume lower amounts of protein
and other nutrients, including fibers,
carbohydrates, and some vitamins, because
they avoid ample food types, especially fresh
fruits and uncooked vegetables when
compared with other groups of population.

5. • Poor diet coupled with a sedentary
lifestyle are known to be risk factors for
debilitating diseases such as, Diabetes
mellitus, Hypertension, Heart disease,
Stroke, Kidney and liver disorders, Cancer,
etc,.
• Loose dentures,sore spots under denture,
severely resorbed mandible, difficulty in
chewing, eating less food, inability to
arrange food for oneself, unexpected
weight gain or weight loss,alcohol or drug
abuse, undergoing chemotherapy or
radiation therapy can be considered as risk
factors for nutritional deficiencies.

6. Definitions
• Nutrition is the biochemical and physiological
process by which an organism uses food to support
its life. It provides organisms with nutrients, which
can be metabolized to create energy and chemical
structures.
• Malnutrition occurs when the body doesn't get
enough nutrients. Causes include a poor diet,
digestive conditions or other diseases.
• RDA(Recommended Daily Allowances)
• The Recommended Daily Allowance (RDA) is defined
as the average daily dietary nutrient intake level
sufficient to meet the nutrient requirement of
nearly all (97 to 98 percent) healthy individuals in a
particular life stage and gender group.

7. Factors
influencing
Malnutrition
in Elderly
• Patient factors
• Physiological and anatomical factors
• Psychological and financial factors

8. Patient
factors
• The food choices of patient may be altered
due to – Fear of food lodgment – Fear of
choking – Hysteria
• Some people tend to compensate for
decline in masticatory ability by choosing
cooked or processed food over fresh food
which creates a nutritional imbalance.
• Most of the elders these days are under
many medications which may cause
anorexia, nausea, gastrointestinal
disturbances, and interfere with nutrient
absorption and utilization.

9. Physiological
and
anatomical
factors
Changes are seen in :
Skin
Mucosa
Bone
Muscle
Teeth
Taste and smell

10. • Changes in skin:
• Subcutaneous connective tissues provide the
main storehouse for water
• The skin wrinkles with aging usually due to
water loss from the subcutaneous connective
tissues
• This changes the firm, turgid, soft tissues of
children and young adults to the pale, dry, and
wrinkled cheeks, neck, arms, and thighs, of the
elderly
• The face shows the wrinkling effects of negative
water balance and dehydration early

11. • Changes in the mucosa
• Xerostomia is due to the diminished secretion of saliva
• The oral mucous membranes become hot, dry, and fragile
• Dentures cannot be tolerated by the dry and fragile
mucosa
• Even the most skilfully fabricated denture may fail in the
dry mouth
• Mastication of dry foods becomes difficult, so the elderly
are restricted to soft foods and soups
• Reasons for xerostomia include dehydration,salivary gland
disorders,certain medications and hormonal changes.
• The most common vesiculoerosive conditions (VEC) like
oral lichen planus, mucous membrane pemphigoid, and
erythema multiforme may develop
• Systemic lupus erythematosus has been reported to favor
women over men at a ratio of 10:1
• Burning mouth syndrome also develops more frequently
in the elderly due to hormonal changes, mechanical
irritations, xerostomia etc

12. • Changes in bone
• Turnover and metabolism are influenced by many factors
including exercise, genes, hormones, and nutrition, but
usually, resorption surpasses formation somewhere
around midlife in both men and women
• Osteoporosis happens usually, but not exclusively after
menopause and is discovered frequently when an older
person breaks a vertebra, hip, or forearm
• Residual ridge resorption may be a manifestation of
osteoporosis
• Loss of bone can occur because of lack of calcium intake
or lack of calcium absorption or lactase deficiency
affecting the functions of bone

13. • Changes in muscle
• The total muscle mass in the body contains 50
percent of body water
• With aging the muscle mass shrinks, becoming
thin and stringy due to water loss. This results in
the sagging of all muscles
• Muscle strength diminishes and facial contours
collapse
• Muscle tone is important in assessing the
prognosis of the prosthesis

14. • Changes in Secretions
• Due to dehydrations in elderly, sweat and
sebaceous gland secretions diminish, causing
dryness of skin
• The normal secretions of hydrochloric acid in the
stomach and all digestive enzymes in the
intestine decrease in volume if water intake is
deficient

15. • Changes in Jaw movements
• Although age per se has little effect on the ability to chew,
people usually chew more slowly, and with less vertical
movement of the mandible as they age
• Movements of the mandible are governed by a generator
in the brain stem influenced by proprioceptors in muscles,
joints, and mucosa
• Advancing age may delay the central processing of nerve
impulses, impede the activity of striated muscle fibers,
and inhibit decisions
• It can reduce also the number of functional motor units
and fast muscle fibers, and decrease the cross-sectional
area of the masseter and medial pterygoid muscles
• Consequently, older people tend to have poor motor
coordination and weak muscles
• Muscle tone can decrease by as much as 50% in the
elderly

16. • Changes in Taste and Smell
• Sensitivity to taste declines with age and
especially with Alzheimer’s disease
• Although the preference for specific flavors also
may change over time, complaints of an
impairment affecting the sense of taste at any
age should be investigated thoroughly because
they forebode an upper respiratory infection or
a serious neurological disorder

17. Psychological
and financial
changes
• Due to lack of financial stability, affordability
for nutritious foods and maintenance of
health decreases.
• Age related psychological changes like
dememtia affect the mental status of patient

18. Prosthodontic
considerations
• Patient evaluation
• Patient education and motivation
• Postinsertion instructions and follow up
• Using better techniques for fabrication of
dentures

19. • Patient evaluation:
• Proper history and clinical examination help
the dentist to arrive at proper diagnosis and
deliver correct treatment.

20. • Patient education and motivation:
• It is done to improve the nutrition in
edentulous patients.
• Here proper guidelines are given to patients
regarding different components of nutrition
like carbohydrates, proteins, vitamins and
minerals and hydration.(Dietary counselling)
• It can be explained verbally along with
pamphlets.

21. • Post insertions and follow up:
• First Postinsertion Day:
• Vegetable-Fruit group: Fruit or vegetable juices are advised. In
addition to providing necessary nutrients, juices also produce
a soothing effect in the oral cavity of the patient.
• Bread-Cereal group: Softened bread or cereals mixed in liquid
consistency can be recommended to maintain protein levels of
the body.
• Milk group: Fluid milk is included in the dietary pattern which
serves as rich source of calcium and prevents conditions like
osteoporosis.
• Meat group: Meats made into puree form, meat broths or
soups which are more palatable and easier to swallow can be
instructed. As the geriatric age group is more prone to
physiologic muscle loss and bone resorption, two glasses of
milk has to be added to the dietary menu to prevent
osteoporosis.

22. • Second and Third Postinsertion Day
• Vegetable-Fruit group: Juices; seedless and peeled
fruits cooked vegetables in semi-solid consistency.
• Bread-cereal group: Cooked cereals, rice porridge,
soft noodles or pasta, crushed bread powder with
milk.
• Milk group: Milk and melted cottage cheese can be
directly consumed.
• Meat group: Tenderly cooked chicken, finely cut
beef, thick broth or soups, fish liver with thick
cream, etc. The sample menu must include
consumption of any two dairy products (milk,
butter, cheese, etc.) at least once a day.

23. • Fourth Day and After
• With the usage of dentures together with
denture hygiene, the sore spots which were
once painful and red creating inconvenience
to the patient tend to heal.
• The patient can shift the dietary needs from
soft fluid diet to a solid diet. Care must be
taken to prevent gagging or choking. This is
done the cutting the food into smaller bits
before consumption until the patient gets
adapted with the prosthesis

24. • Using better techniques for fabrication of
dentures:
• Ex:
• For Xerostomia patients: Reservoir dentures
• For severely resorbed ridges: Neutral zone
technique
• Implant supported overdentures for
resorbed ridges

25. Nutritional
Guidelines
For Elderly
• The recommended dietary requirement calls
for an average caloric intake of 2400Kcal for
men and 2000Kcal for women.
• Health problems arise when intake is less
than 1600Kcal per day.
• Out of daily caloric intake 60% should come
from carbohydrates,25% from fats, 15% from
proteins.

26. • Carbohydrates:
• Choose complex carbohydrates like peas,
beans, whole grains, and vegetables.
• Proteins:
• Adequate protein intake is essential for
senior citizens
• Animal proteins like meat, egg, milk, paneer
• Plant proteins like pulses, soybeans, peas,
mushrooms

27. • Fats:
• Saturated fats:
• Cream, butter, yolk of egg, meat, ghee,
coconut oil
• Unsaturated fats:
• Mono unsaturated fats like olive oil, mustard
oil
• Polyunsaturated fats like refined oil
• Emphasis should be on choosing
unsaturated fat

28. • Vitamins and minerals:
• Important vitamins are Vitamin A,D,E,C,
Vitamin B6 and Vitamin B12.
• The sources are green leafy vegetables, fish
oil, cod liver oil, sprouts, carrots, citrus
fruits, etc,.
• Important minerals are calcium, zinc, copper,
iron, sodium, potassium.
• The sources are green leafy vegetables,
fruits, milk.

29. • Water:
• Though water has no caloric value, it should
be taken in sufficient quantity along with
food or otherwise.
• The fluid intake should be 1.5 to 2 lts per day
in a normal elderly person.
• Fibre:
• Elderly require sufficient fibre or roughage in
their diet to avoid constipation.
• The tender fibre of vegetables, fruits and
whole grain cereals are well tolerated by
elderly

32. A food pyramid is a representation of the optimal number of
servings to be eaten each day from each of the basic food
groups.

33. Conclusion
• Complete denture wearers are always at a
greater risk of malnutrition than normal
population. Regular monitoring of
nutritional status of complete denture
wearers is important to prevent morbidities
and complications associated with
malnutrition.
• Dietary counseling and analysis should be
incorporated into the treatment sequence of
fabrication of denture prosthesis.

34. References
• A Primer on Complete denture prosthodontics by K Chandrashekar
Nair
• Essentials of complete denture prosthodontics by Sheldon Winkler
• Textbook of complete dentures 5th edition by Arthur O Rahn and
Charles M Heartwell
• Joshipura KJ, Willet WC, Douglass CW. The impact of edentulousness
on nutrition and food intake.
• J Am Dent Assoc 1996 Apr;127(4):459-467. 2. Lochs H,Allison SP,
Meier R, Pirlich M, Kondrup J, Schneider S, van den Berghe G, Pichard
C.
• Introductory to the ESPEN Guidelines on enteral nutrition:
terminology, definitions and general topics. Clin Nutr 2006
Apr;25(2):180-186. 3. Cousson PY, Bessadet M, Nicolas E, Veyrune JL,
Lesourd B, Lassauzay C.
• Nutritional status, dietary intake and oral quality of life in elderly
complete denture wearers. Gerodontology 2012 Jun;29(2):e685-
e692.